4 - (IOP 2) Positive Auditory Verbal Hallucination Prevalence, Content and Predictors in a Large-scale Culturally Diverse Early Intervention in Psychosis Service: Implications for Early Intervention CBT

Auditory Verbal Hallucinations (AVH) are the most common hallucination experienced by first-episode psychosis patients (Rajapakse et al., 2011). Positive AVH’s are common in chronic psychosis (Jenner et al., 2008), predicting both treatment non-compliance (Miller et al., 1993) and harmful compliance with AVH commands (Shawyer et al., 2008; Junginger et al., 1995). However, research on Positive AVH content is limited, especially in early course psychosis and culturally diverse populations. Yet, this knowledge is a pre-requisite for the next generation of precision CBT for psychosis (Newman‐Taylor & Bentall, 2023), including innovative treatments like avatar therapy to reduce AVH-related distress (Garety et al., 2024).

To address these critical knowledge gaps, our registered Quality Improvement Project surveyed the content and interpretation of Positive AVH in patients in an early intervention psychosis service. This project will disseminate data to inform local service planning, staff training, patient education and CBT. This is an ongoing partnership between the United Kingdom National Health Service and University College London to advance postgraduate public education by conducting scientific investigations in healthcare settings with multiple stakeholders.

The sample (N = 740) were patients diagnosed with psychosis according to ICD criteria. Routine health records were scrutinised and coded for presence of Positive AVH if either the AVH content or their interpretation of it was Positive. Sixty-eight AVH variables identified as clinically useful from AVH literature were pre-selected, covering biological, psychological and social gains. The prevalence (N, %) for each variable was calculated. Positive AVH predictors were identified using univariate analyses and multiple logistic regression, comparing Positive and non-Positive AVH patients on key sample characteristics such as duration of untreated psychosis (DUP) and illness length.

Results revealed that 24% (N = 181) of the sample experienced Positive AVH and 76% (N = 559) did not. These patients, aged 13-36 years (M = 25.3 years) had a short psychosis illness length (M = 25.3 months) and DUP (M = 1.5 months). With 29 ethnicities and 13 religions represented, this project is the most culturally diverse, comprehensive survey of Positive AVH in early course psychosis to date. Results of who experiences Positive AVH, their prevalence, predictors, when they occur, and the impact of early versus later intervention will be presented at the conference.

This project contributes extensive new empirical data to advance scientific understanding of Positive AVH, in both voice content (Larøi et al., 2019) and beliefs about AVH (Chadwick & Birchwood, 1994). This will inform the underdeveloped field of CBT for Positive AVH, especially early intervention for culturally diverse patients. The data can inform all stages of CBT for AVH, such as initial screening, engagement, assessment, formulation, intervention targets and outcome evaluation. Specific potential outcomes include reducing CBT disengagement and compliance with harmful commands in Positive AVH, as well as reducing iatrogenic harm by preserving the benefits patients derive from their Positive AVH.